Outpatient protocol for biofeedback therapy of pelvic floor outlet obstruction

James W. Fleshman, Zeev Dreznik, Kathleen Meyer, Robert D. Fry, Robert Carney, Ira J. Kodner

Research output: Contribution to journalArticlepeer-review

90 Scopus citations

Abstract

Pelvic floor outlet obstruction is a rare cause of severe constipation. Anal myectomy, subtotal colectomy, and medical therapy have limited success. The purpose of this study was to develop a short outpatient treatment using biofeedback techniques. Nine patients with severe constipation and straining resulting from pelvic floor outlet obstruction underwent complete investigation of the pelvic floor musculature and anal sphincter mechanism. Patients were unable to expel a 60-cc rectal balloon and had nonrelaxing puborectalis on defecography. The treatment protocol utilized anal surface electromyography to document improper straining and retrain pelvic floor muscles to relax during defecation. Sensory retraining with a rectal balloon, behavioral relaxation techniques, and defecation of simulated stool using a 120-cc Metamucil® (Procter & Gamble, Cincinnati, OH) slurry in the rectum allowed re-establishment of normal defecation in all nine patients. Repeat training was required in three patients during follow-up. Treatment of pelvic floor outlet obstruction with outpatient retraining techniques is possible.

Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalDiseases of the Colon & Rectum
Volume35
Issue number1
DOIs
StatePublished - Jan 1 1992

Keywords

  • Balloon expulsion
  • Biofeedback
  • Constipation
  • Defecography
  • Nonrelaxing puborectalis

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